Healthcare Provider Details

I. General information

NPI: 1831986710
Provider Name (Legal Business Name): TANYA ESTAVIEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2025
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74 RIVER BEND RD UNIT B
STRATFORD CT
06614-8099
US

IV. Provider business mailing address

74 RIVER BEND RD UNIT B
STRATFORD CT
06614-8099
US

V. Phone/Fax

Practice location:
  • Phone: 203-722-2272
  • Fax: 203-722-2272
Mailing address:
  • Phone: 203-722-2272
  • Fax: 203-722-2272

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number14731
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4061264
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number14731
License Number StateCT
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number14731
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: